The STarT Back and Specific Treatment of Problems of the Spine (STOPS) back pain trials both evaluated the effect of individualising treatment to the specific features of each patient’s presentation. The STarT Back trial did this based on psychosocial prognostic factors thought to predict long-term back pain, and the screening tool derived from that has been incorporated into the current NICE guidelines on the management of back pain. The STOPS trial is less well known and unique in that treatment was tailored to both specific psychosocial factors and clinically familiar pathoanatomical factors. Both studies had good results in terms of outcome. The STOPS trial deserves closer attention and is the focus of this article because it provides, for the first time, evidence that a comprehensive and pragmatic application of pathoanatomical specific treatment is of value to back pain patients. Perhaps, more importantly, its results also challenge some long-standing assumptions about the importance of psychosocial factors in predicting chronic low back pain.